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Sem 4, case 3 (pancreatitis) > alcohol use and abuse (lecture) > Flashcards

alcohol use and abuse (lecture) Flashcards

1
Q

How many deaths are related to alcohol abuse each year ?

A

3 million worldwide

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2
Q

Where does alcohol abuse rank in the leading causes of death ?

A

7th leading cause of death

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3
Q

Which age range is most likely to present with alcohol dependence/harm ?

A

35 - 54

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4
Q

How does alcohol interact with sleep?

A

decreases the quality of sleep by interrupting the sleep cycle

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5
Q

What is dipsomania?

A

alcoholism characterised by intermittent cravings for alcohol

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6
Q

What is Potomania ?

A

electrolyte disturbance brought bout by the dilution effect of drinking lots of beer

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7
Q

What are the ICD-11 criteria for diagnosing alcohol dependence

A
  • disordered regulation/control of alcohol use
  • repeated/continuous use of alcohol
  • strong internal drive to use alcohol
  • prioritisation of alcohol over other activities
  • persistent use despite harms
  • present for 12 months (or 1 month if very serious/continuous)

= chronically relapsing disorder

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8
Q

Which neurotransmitter system is down regulated by alcohol ?

A

GABA-A

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9
Q

Which neurotransmitter system is up regulated by alcohol ?

A

Glutamate

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10
Q

What is involved in the CAGE alcohol questionnaire ?

A

C - has patient ever felt a need to cut down on their drinking ?
A - have people annoyed them by criticising their habits ?
G - have they ever felt guilty about drinking ?
E - has patient used alcohol as an eye-opener = first thing in the morning to steady nerves/reduce hangover etc

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11
Q

Is the CAGE questionnaire seen as an effective method of assessing alcohol dependance ?

A

Not really, better than nothing but the ICD-11 criteria and WHO AUDIT are better methods

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12
Q

Which tool is considered the gold standard method of diagnosing alcohol dependence ?

A

WHO AUDIT
(FAST version in a&e)

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13
Q

What is the UK guidance for ‘safe drinking’ ?

A

14 units per week, spread over 3 days at least

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14
Q

What does an ABV of 12% mean in terms of how much alcohol is in that bottle?

A

12% ABV = 12% of the bottle is alcohol

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15
Q

How much pure alcohol (ml and g) is in 1 unit ?

A

10ml = 8g

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16
Q

What is a quick way to estimate units ?

A

ABV in 1000ml = units

e.g…
1000mls of 5% beer = 5 units
500mls of 10% wine = 5 units

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17
Q

What effect does frequent binge drinking at 18-25yrs old have on future risk of alcohol dependence ?

A

2-3x higher risk

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18
Q

How many calories are there in 1g of pure alcohol ?

A

7.1 calories

(almost double that of 1g of carbs)

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19
Q

What does the ‘J shaped curve’ in alcohol study show about alcohol and mortality ?

A
  • some alcohol is protective against mortality
  • on the whole, the more drinks per day = higher mortality risk

this study has been debunked now

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20
Q

What are some effects of alcohol on the oesophagus ?

A
  • increased cancer risk (esp. squamous cell carcinoma)
  • oesophageal varices (enlarged veins) associated with liver disease
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21
Q

How might oesophageal varices present ?

A
  • drop in Hb due to varices bleeding
  • raised urea
  • coffee-ground vomit
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22
Q

What are some effects of alcohol on the stomach ?

A
  • acute gastritis
  • acute ulceration
  • chronic peptic ulceration
  • portal gastropathy
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23
Q

What are the mechanisms of alcohol related liver disease ?

A
  • direct toxic effects
  • indirect metabolite effect
  • causes activation of free radicals
  • causes induction of enzyme systems
  • causes nutritional deficiencies (B12, thiamine)
  • causes liver function impairment
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24
Q

What are the effects of alcohol on the pancreas ?

A
  • acute pancreatitis
  • chronic pancreatitis
25
Q

How does acute pancreatitis present ?

A
  • severe abdominal pain
  • radiating to back
  • nausea/vomiting
  • greatly elevated serum amylase
26
Q

How does chronic pancreatitis present ?

A
  • intermittent severe upper abdominal and back pain
  • weight loss
  • exocrine tissue replaced by fibrosis
  • leads of pancreatic malabsorption (steatorrhoea, reduced vitamins)
  • relative preservation of endocrine tissue
27
Q

What % of heavy drinkers progress to alcoholic hepatitis or cirrhosis ?

A

10-20 %

28
Q

By how much does >9 units/day increase a womans risk of alcohol liver disease ?

A

> 9 units/day = 12x increased risk in women

29
Q

By how much does >9 units/day increase a mans risk of alcohol liver disease ?

A

> 9 units/day = 4x increased risk in men

30
Q

Are men or women at greater risk of alcohol liver disease ?

A

women are at higher risk, even at lower amounts of alcohol

31
Q

What does obesity do to the risk of developing alcohol liver disease ?

A

obesity doubles the risk

32
Q

What is the progression of alcoholic liver disease ?

A
  1. acute fatty change reversible
  2. hepatic fibrosis reversible
  3. cirrhosis irreversible
  4. hepatic decompression fatal

acute hepatitis can occur along the way

33
Q

What are some physical presentations of liver failure ?

A
  • jaundice
  • ascites (very round belly)
34
Q

What are some effects of alcohol on the heart ?

A
  • atrial fibrillation
  • MI (heart attack)
  • congestive heart failure (cardiomyopathy)
35
Q

What are some neuropsychiatric disorders associated with alcohol dependance ?

A
  • seizures in withdrawal (10% mortality)
  • delirium tremens = delirium/hallucinations in withdrawal
  • wernicke’s encephalopathy = acute delirium, ataxia, ophthalmoplegia
  • korsakoff’s psychosis = chronic tried of short term memory loss, confabulation, ataxia (secondary to thiamine deficiency)
  • polyneuropathy (secondary to B12/thiamine deficiency)
36
Q

How does delirium tremens present ?

A

delirium with hallucinations and autonomic disturbances in alcohol withdrawal

confusion, paranoia etc

37
Q

How does Wernicke’s encephalopathy present ?

A

acute:
- delirium
- ataxia
- ophthalmoplegia

38
Q

How does Korsakoff’s psychosis present ?

A

chronic triad of:
- short term memory loss
- confabulation
- ataxia

doesn’t have to be all 3

39
Q

When is the peak incidence of siezures within a withdrawal period ?

A

1-2 days after cessation of drinking

40
Q

Does delirium tremens present early or late in the withdrawal period from alcohol ?

A

later

41
Q

How does the severity of withdrawal symptoms change with each relapse ?

A

withdrawal symptoms get worse with each withdrawal period

42
Q

What effect does regular drinking have on GABA-A receptor function?

A

the body down regulates GABA-A receptors, because alcohol is a GABA-A agonist so the body thinks there’s plenty of it

43
Q

What effect does regular drinking have on NMDA receptor function?

A

the body up regulates NMDA receptors because alcohol is an NMDA (glutamate) antagonist

44
Q

What is the mechanism of alcohol inducing seizures ?

A

The imbalance between GABA-A and glutamate, befuase alcohol…
- down regulates GABA-A receptors
- up regulates NMDA receptors

45
Q

What drugs can be used to reduce chances of alcohol induced seizures ?

A

benzodiazepines (for GABA-A system)
- chlordiazepoxide
- diazepam

Thiamine (for NMDA system)

46
Q

What is in the drug Pabrinex ?

A

thiamine

47
Q

Which drug is used in alcohol relapse prevention ?

A

Acamprosate

48
Q

What is myopathy ?

A

weakness and dysfunction in skeletal muscle

49
Q

Which muscles are most affected by myopathy as a result of alcohol dependence ?

A

proximal muscles in pelvic girdle

50
Q

What is the physiology of thrombocytopenia as a result of alcohol dependence ?

A
  • alcohol is toxic in bone marrow = leads to reduced normal cell levels
  • effects on the liver leads to folate deficiency which affects blood cells
51
Q

What is thrombocytopenia?

A

platelet deficiency

52
Q

What is pancytopenia ?

A

deficiency of all major cells in blood
white, red, platelets

53
Q

Describe the process of alcohol metabolism …

A
  1. Ethanol —> acetaldehyde
    via
    - alcohol dehydrogenase
    - catalase
    - P4502E1(microsomes)
  2. Acetaldehyde —> acetate
    via aldehyde dehydrogenase
54
Q

Which step of alcohol metabolism does the drug Disulfiram inhibit ?

A

acetaldehyde —> acetate

55
Q

Which enzyme does the drug Disulfiram inhibit ?

A

aldehyde dehydrogenase

56
Q

What is the reaction like if a person drinks while on disulfiram ?

A

Bad reaction
- nausea
- tachycardia
- palpitations

57
Q

What is the idea behind prescribing disulfiram to stop alcohol dependence ?

A

the drug interacts with alcohol metabolism in a bad way so the effects are so unpleasant that people will stop drinking on their own accord

58
Q

What are some non-medication methods of reducing alcohol dependence ?

A
  • patient makes a drink diary
  • consider behaviour changes
  • assess trigger points
  • swap to a lower strength alcohol
  • don’t go cold turkey - drink at a lower level to prevent withdrawal symptoms
  • refer to drug/drink services

Sem 4, case 3 (pancreatitis) (4 decks)

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